Departamento de Psicología Experimental, Procesos Cognitivos y Logopedia, Facultad de Psicología, Universidad Complutense de Madrid, España.
Hospital General Universitario Gregorio Marañón, Madrid, España.
J Alzheimers Dis. 2020;77(2):641-653. doi: 10.3233/JAD-200586.
Recent research pointed to executive dysfunction as a potential early predictor of the progression of mild cognitive impairment (MCI) to dementia in Alzheimer's clinical syndrome (ACS). Such cognitive impairments account for functional impairments in instrumental activities of daily living (IADL).
The present study analyzes the contributions of executive functions to predict MCI-dementia progression in ACS.
We assessed 145 participants, 51 cognitively unimpaired and 94 MCI. The latter were divided using the traditional, memory-based MCI classification (single domain amnestic, multidomain amnestic, and non-amnestic). Eight tests assessing executive functions were administered at baseline and at 1-year follow-up, together with cognitive screening tools and IADL measures. MCI patients were reclassified based on the outcomes from a K-mean cluster analysis which identified three groups. A simple lineal regression model was used to examine whether the classification based on executive functioning could more accurately predict progression to dementia a year later.
Clusters based on executive function deficits explained a significant proportion of the variance linked to MCI-dementia conversion, even after controlling for the severity of MCI at baseline (F(1, 68) = 116.25, p = 0.000, R2 = 0.63). Classical memory-based MCI classification failed to predict such a conversion (F(1, 68) = 5.09, p = 0.955, R2 = 0.07). Switching, categories generation, and planning were the executive functions that best distinguished between MCI converters and stable.
MCI with a dysexecutive phenotype significantly predicts conversion to dementia in ACS a year later. Switching abilities and verbal fluency (categories) must be evaluated in MCI patients to assess risk of future dementia.
最近的研究表明，执行功能障碍可能是阿尔茨海默病临床综合征（ACS）中轻度认知障碍（MCI）向痴呆进展的潜在早期预测指标。这种认知障碍会导致日常工具性活动能力（IADL）的功能障碍。
本研究分析了执行功能对预测 ACS 中 MCI 向痴呆进展的贡献。
我们评估了 145 名参与者，其中 51 名认知正常，94 名 MCI。后者根据传统的基于记忆的 MCI 分类（单一领域健忘型、多领域健忘型和非健忘型）进行了细分。在基线和 1 年随访时，共进行了 8 项评估执行功能的测试，同时还进行了认知筛查工具和 IADL 测量。根据 K-均值聚类分析的结果对 MCI 患者进行了重新分类，该分析确定了 3 个组。使用简单线性回归模型来检查基于执行功能的分类是否可以更准确地预测一年后向痴呆的进展。
基于执行功能缺陷的聚类解释了与 MCI 向痴呆转化相关的大量方差，即使在控制基线时 MCI 的严重程度后也是如此（F(1, 68) = 116.25，p = 0.000，R2 = 0.63）。基于经典记忆的 MCI 分类无法预测这种转化（F(1, 68) = 5.09，p = 0.955，R2 = 0.07）。转换、类别生成和计划是区分 MCI 转化者和稳定者的最佳执行功能。
具有执行功能障碍表型的 MCI 显著预测 ACS 中一年后向痴呆的转化。在 MCI 患者中，必须评估转换能力和言语流畅性（类别），以评估未来痴呆的风险。
